Although unsintered hydroxyapatite and poly-l-lactic acid (u-HA/PLLA) composite sheets have various applications, such as in craniomaxillofacial fractures, orthognathic surgery, and orthopedic surgery, and have been proven to be safe and effective, no studies have reported the use of u-HA/PLLA composite sheets for orbital wall reconstruction with long-term follow-up. This study reports our preliminary results using the u-HA/PLLA composite sheet for orbital wall fractures. The SuperFIXSORB MX sheet (u-HA/PLLA composite sheet; Takiron, Tokyo, Japan), with size of 30 × 50 mm and thickness of 0.5 mm, was used in all cases of hard reconstruction of the orbital bone defect. Seventy-two patients with acute orbital wall fractures (within 2 weeks after sustaining the injury) treated at the Jikei University between January 2014 and August 2016 were included. The authors evaluated the postoperative complications and the operability of the material. The authors did not observe any postoperative complications, such as infection, postoperative diplopia, or enophthalmos, due to the use of the u-HA/PLLA composite sheet. In pure orbital fractures (orbital fractures only), the mean (±standard deviation) operation time was significantly longer with combined inferior and medial wall fractures (201.1 ± 36.6 minutes; n = 11) than with inferior wall or medial wall fractures only (135.0 ± 54.4 minutes; n = 51) (Mann–Whitney U test, P < 0.001). The U-HA/PLLA composite sheet is safe and can be used for orbital wall fracture reconstruction. Further long-term functional and aesthetic assessments for infection, ocular movement disorder, enophthalmos, and any other complication are necessary.

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We have used the technique of open septorhinoplasty since in combined surgery in collaboration with ENT surgeons, as to improve nasal function and esthetics. This approach covers a wide variety of nasal pathologies including nasal valve obstruction, post-traumatic nasal obstruction, caudal septal deviation, and post-conventional septoplasty with worsening of nasal obstruction. Here, we describe the importance of manipulating the caudal septum in treatment of caudal septal deviation. Operation: Thorough a transcolumellar incision with infra-cartilagenous extension, the interdomal ligament was divided to approach the anterior angle of the septal cartilage to obtain access for sub-mucoperichondrial dissection. Septoplasty and conchal surgery are performed as needed by an ENT surgeon. If caudal deviation is moderate, it can be straightened by freeing the septum from the upper lateral cartilages. If the posterior angle of the septum is dislodged from the anterior nasal spine ANS , the posterior septal angle is freed, trimmed and sutured to the ANS. If the posterior septal angle is toward the ANS, the length of the caudal septum can be adjusted in the middle and reinforced with a batten graft. Discussion: The pathologies of the anterior septal angle without dislocation from the anterior nasal spine are relative overload on the caudal septum from the dorsal cartilaginous component of the nose, which includes a frail septum, misbalance of the septal cartilage and surrounding bony structures, and intrinsic torsional memory of the cartilage. If septal cartilage is dislodged from the ANS, the pathology is more likely to be due to a previous trauma. Understanding the pathology of caudal septal deviation is essential in straightening and centralizing the septal cartilage.

Purpose Caudal septoplasty is a difficult procedure. The cutting and suture technique is suitable for caudal septoplasty, but a batten graft is always necessary and bears the risk of nasal tip projection loss. We established a modified cutting and suture technique (MCAST), without using a batten graft, and investigated its effectiveness in correcting nasal obstruction and preventing nasal tip projection loss. Methods We retrospectively reviewed the medical records of 22 patients who underwent caudal septoplasty using MCAST. Subjective assessment by Nasal Obstruction Symptom Evaluation (NOSE) score and objective assessment by computed tomography (CT) were performed before and after the surgery. For evaluating nasal tip projection, we asked patients about their awareness of external nasal deformity. Additionally, the nasal tip projection was measured by CT and compared before and after surgery. Results The median preoperative NOSE score reduced significantly after MCAST (P < 0.001). On CT, the ratio of the area of the convex side to that of the concave side in the anterior portion of the nasal cavity increased significantly after MCAST (P < 0.001). All patients were unaware of external nasal deformity. There were no significant differences in the mean preoperative and postoperative nasal tip height and nasolabial angle. The mean supra tip height was significantly greater postoperatively than preoperatively (P = 0.02). Conclusions The MCAST was useful for correcting nasal obstruction with caudal septal deviation. There was no postoperative loss of nasal tip projection. The MCAST can be suitable for correcting C-shaped caudal deviations without dislocating the caudal septum from the anterior nasal septum.